Payment Integrity Consultant

UnitedHealth Group•Tampa, FL

7h•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

Requirements

High School Diploma / GED
Must be 18 years of age OR older
3+ years of experience reviewing claims data with contractual reimbursement and payment policy review, to identify incorrect reimbursement
2+ years of experience analyzing data to identify new overpayment and / OR cost - saving opportunities
2+ years of experience working as a claims auditor, independently without direct supervision
Experience performing independent research to work toward creative solutions
Experience recalculating expected claim reimbursement
Experience with Microsoft Office including Microsoft Word and Microsoft Outlook
Experience identifying and presenting trends in large datasets
Advanced Microsoft Excel experience (formula creation, Pivot Tables/VLOOKUP), OR experience working with SQL (basic scripting experience)
Ability to work Monday - Friday, in any of our shift schedules during our normal business hours of 8:00am - 5:00pm CST

Nice To Haves

Experience identifying payment errors by reviewing data
Experience reviewing claim data with COB (Coordination Of Benefits)
Medical coding knowledge OR experience

Responsibilities

Become an expert in assigned clients payment systems and policies
Identify issues with client overpayments through the advanced analysis of client data
Present overpayments to client through documentation and concept presentations
Document all new concepts and train internal analysts on identification and correct payment calculations
Maintain existing productions queries and enhance or correct as necessary
Achieve annual trend approval rate goals
Serves as a resource to others on issues pertaining to client policies and overpayment concepts
Other duties/projects as assigned